As the trail dips past the creek and the sun crests the sky, something catches the corner of my eye. I immediately sense I am in trouble; this is how my life will end, presaged by the signpost at the trailhead.
I have a friend who is convinced everyone who lives in Colorado will die in a mountain lion attack. If pushed, she may allow a soul or two to be gobbled up by a bear. But the mountain lion—a.k.a. cougar—will get the, well, lion’s share of us. To her, everyone who ventures out into the wild for a hike, mountain bike or snowshoe adventure is just biding time, simmering away in the cougar’s crock, eventual forest filet for our feral friends.
Prior to a hike, I’ll often call up her various bits of wisdom, such as never hike alone, wear a bell, bring a whistle, carry mace (both the atomized spray and the medieval warring device, I presume). All this in the name of preventing or fending off a predator’s attack. This always has struck me as a bit paranoid, especially considering only 20 deaths by mountain lions have been recorded in all of North America since 1890. Still, this friend is unwaveringly convinced mountain lions pose a real threat to life and limb. And for the time being, hiking alone, I can’t help but share her fear.
Just a quick blur; then nothing. Pupils dilating, palms moist, I slowly pivot, centering my peripheral vision on my attacker.
It always struck me that there are things in life we tend to fear and things we tend to trust, and more often than not we get them confused. To be sure, mountain lion and bear attacks do happen, but are exceedingly uncommon. Ditto plane crashes. While most of us harbor at least a modicum of fear of perishing in a plane crash, it’s nearly impossible to die in such a manner. By one estimate, a modern commercial airline traveler would need to fly continuously for nearly 20,000 years to reach a 50-50 chance of death by plane crash. To put it another way, the chances of dying on your next flight are one in a many million, roughly the same as winning the lottery. People do win the lottery, but you and I probably won’t.
Reaching for my pepper spray, I am struck by the fact I don’t hike with pepper spray. But I am carrying a sizable rock—I picked it up a mile back—and I slowly turn it over in my palm preparing to crush the skull of my ambusher.
Then there are the things we should fear: cars, guns, fishing.
The average U.S. adult has about a one in 6,500 chance of dying in a car accident every year. This means you are infinitely more likely to die on the road than in the air (a one in 430,000 chance of death per annum). Also more likely to do you in are firearms, which are 17 times more likely to kill you than air travel (1 in 25,000). Oddly perilous is fishing. Statistically speaking, there is one death annually for every 1,000 fisherman. Now, growing up in northern Wisconsin I spent the bulk of my formative years in a boat with drunken fishermen. Still, I was surprised to learn fishing is so mortal. However, it turns out commercial—not recreational fishing—is the most dangerous occupation in America.
The White Elephant
Heart in torsades, I tried to recollect whether a lion attack merited I run or remain still-but-menacing. Paralyzed by indecision, I coaxed a scowl across my face, just in case it was the latter.
Then there is the thing we should all truly fear, U.S. healthcare.
As many as one in 200 individuals hospitalized in the U.S. will die from an adverse event during a hospital stay. This doesn’t include the numerous people who come into the hospital with a disease, such as pneumonia, and die of pneumonia. Rather, these are patients who come into the hospital with pneumonia and die from an anaphylactic penicillin reaction, which doctors overlooked on their allergy list or from a pulmonary embolism doctors forgot to prophylax against.
Two landmark patient safety studies, respectively, revealed 2.9% and 3.7% rates of medical error in hospitals. Moreover, in these two studies, 6.6% and 13.6% of the errors led to death, respectively. That means roughly one in 30 patients suffered a medical error with one in 10 of those errors resulting in death. Further math reveals 0.2% to 0.5% of overall hospitalized patients will die from a medical error. In other words, the patient awaiting admission orders in your emergency department right now has a 1 in 200 to 1 in 500 chance of death from an error your hospital or its staff will make. Now that’s something to really fear.
Not all of these deaths are avoidable; however, many of the nearly 100,000 annual deaths from adverse events are preventable. Furthermore, these events represent just the tip of the iceberg. Millions more errors yield mere morbid outcomes, or do not reach the level of harm, but are nonetheless noteworthy. One study found 19% of all medications administered in the hospital are given erroneously. Basically, only 80% of medications are given correctly.
Think of these numbers the next time you fly. What if the pilot’s post-takeoff announcement assured you there was an 80% chance they’d get you to the correct destination, a 96% chance you’d arrive without the pilot making a serious error, and a 99% chance you’d arrive alive. Would you fly?
Unfortunately, our patients don’t have the option to avoid our hospitals.
Resolved to fight to the death, my assassin slowly came into view. Shrouded in cover, the first thing I noticed about my predator was his eyes, yellow and foreboding as they pierced my soul.
Next, I uncovered his torso, sinewy and compact, ready to pounce.
Finally, his tail, long and tapered—wait, not long but short. Not tapered but bushy.
Just then I heard a child coming up the trail shriek with delight.
“Look mommy, a deer!” TH
Dr. Glasheen is associate professor of medicine at the University of Colorado Denver, where he serves as director of the hospital mdicine program and the hospitalist Training program, and as associate program director of the Internal Medicine Residency Program.
1. Arizona Game and Fish Department. http://www.azgfd.gov/w_c/mtn_lion_attacks.shtml. Accessed November 3, 2008.
2. National Safety Council 2004 statistics. http://www.nsc.org/research/odds.aspx. Accessed November 3, 2008.
3. Centers for Disease Control. http://www.cdc.gov/niosh/topics/fishing/. Accessed November 3, 2008.
4. Thomas EJ, Studdert DM, Burstin HR, et al. Incidence and types of adverse events and negligent care in Utah and Colorado. Med Care 2000;38:261-271.
5. Brennan TA, Leape LL, Laird NM, et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med. 1991;7;324:370-376.
6. Barker KN, Flynn EA, Pepper GA, Bates DW, Mikeal RL. Medication errors observed in 36 healthcare facilities. Arch Intern Med. 2002;162:1897-1903.